119-hr3864

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3864 Introduced in House

    (IH) ]

<DOC>

119th CONGRESS
 1st Session
 H. R. 3864

 To amend title XI of the Social Security Act to prohibit the use of 
 quality-adjusted life years and similar measures in coverage and 
 payment determinations under Federal health care programs.

_______________________________________________________________________

 IN THE HOUSE OF REPRESENTATIVES

 June 10, 2025

 Mrs. Cammack (for herself and Mr. Hern of Oklahoma) introduced the 
 following bill; which was referred to the Committee on Energy and 
 Commerce, and in addition to the Committee on Ways and Means, for a 
 period to be subsequently determined by the Speaker, in each case for 
consideration of such provisions as fall within the jurisdiction of the 
 committee concerned

_______________________________________________________________________

 A BILL

 To amend title XI of the Social Security Act to prohibit the use of 
 quality-adjusted life years and similar measures in coverage and 
 payment determinations under Federal health care programs.

 Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

 This Act may be cited as the ``Protecting Health Care for All 
Patients Act of 2025''.

SEC. 2. PROHIBITING THE USE OF QUALITY-ADJUSTED LIFE YEARS AND SIMILAR 
 MEASURES IN COVERAGE AND PAYMENT DETERMINATIONS UNDER 
 FEDERAL HEALTH CARE PROGRAMS.

    (a) In General.--

Section 1182

    (e) of the Social Security Act (42 
U.S.C. 1320e-1

    (e) ) is amended--

    (1) by inserting ``or treats extending the life of an 
 elderly, disabled, or terminally ill individual as of lower 
 value than extending the life of an individual who is younger, 
 non-disabled, or not terminally ill'' after ``because of an 
 individual's disability'';

    (2) by inserting ``described in the preceding sentence'' 
 after ``such a similar measure'';

    (3) by striking ``The Secretary shall not'' and inserting 
 ``A Federal agency (including the CMI (as described in 

section 1115A)) or State may not'';

    (4) by striking ``under title XVIII.'' and inserting the 
 following: ``under any Federal health care program (as defined 
 in 

section 1128B, except that such term shall include the 
 health program established under chapter 89 of title 5, United 
 States Code).''; and

    (5) by adding at the end the following new sentence: 
 ``Notwithstanding any other provision of law, a Federal agency 
 (including the CMI) or State may not waive the application of 
 the provisions of this subsection (or the provisions of 

section 1852

    (o) , 

section 1860D-12

    (h) , 

section 1902

    (a)

    (88) , 

section 1932

    (b)

    (9) , or 

section 2102

    (e) ) under 

section 1115, 

section 1115A, or any other demonstration or waiver authority.''.

    (b) Conforming Amendments.--

    (1) Medicaid.--
        (A) In general.--

Section 1902

    (a) of the Social 
 Security Act (42 U.S.C. 1396a

    (a) ) is amended--
            (i) in paragraph

    (86) , by striking ``and'' 
 at the end;
            (ii) in paragraph

    (87)
            (D) , by striking the 
 period and inserting ``; and''; and
            (iii) by inserting after paragraph

    (87) the 
 following new paragraph:
 ``

    (88) provide for compliance with the requirements of 
 

section 1182

    (e) (relating to prohibiting the use of certain 
 measures in coverage determinations, reimbursement, and 
 incentive programs).''.
        (B) Managed care organizations.--

Section 1932

    (b) of 
 the Social Security Act (42 U.S.C. 1396u-2

    (b) ) is 
 amended by adding at the end the following new 
 paragraph:
 ``

    (9) Prohibition on use of quality-adjusted life years.--
 The provisions of 

section 1182

    (e) shall apply to the 
 utilization of a dollars-per-quality adjusted life year or 
 similar measure (as described in such section) by a medicaid 
 managed care organization under this title (or a prepaid 
 inpatient health plan or prepaid ambulatory health plan, as 
 defined in 

section 438.2 of title 42, Code of Federal 
 Regulations (or any successor regulation), under a contract 
 with the State) in the same manner as such provisions apply to 
 the utilization of such a year or measure by a State under this 
 title.''.

    (2) CHIP.--

Section 2102 of the Social Security Act (42 
 U.S.C. 1397bb) is amended by adding at the end the following 
 new subsection:
 ``

    (e) Prohibition on the Use of Quality-Adjusted Life Years and 
Similar Measures.--A State child health plan shall provide for 
compliance with the requirements of 

section 1182

    (e) (relating to 
prohibiting the use of certain measures in coverage determinations, 
reimbursement, and incentive programs).''.

    (3) Medicare advantage.--

Section 1852 of the Social 
 Security Act (42 U.S.C. 1395w-22) is amended by adding at the 
 end the following new subsection:
 ``

    (o) Prohibition on Use of Quality-Adjusted Life Years.--The 
provisions of 

section 1182

    (e) shall apply to the utilization of a 
dollars-per-quality adjusted life year or similar measure (as described 
in such section) by an MA plan in the same manner as such provisions 
apply to the utilization of such a year or measure by the Secretary 
under this title.''.

    (4) Medicare part d.--

Section 1860D-12 of the Social 
 Security Act (42 U.S.C. 1395w-112) is amended by adding at the 
 end the following new subsection:
 ``

    (h) Prohibition on Use of Quality-Adjusted Life Years.--The 
provisions of 

section 1182

    (e) shall apply to the utilization of a 
dollars-per-quality adjusted life year or similar measure (as described 
in such section) by a prescription drug plan in the same manner as such 
provisions apply to the utilization of such a year or measure by the 
Secretary under this title.''.
            (c) Implementation.--The amendments made by this section shall 
apply beginning on January 1, 2027.

SEC. 3. PREVENTION AND PUBLIC HEALTH FUND.

 

Section 4002

    (b) of the Patient Protection and Affordable Care Act 
(42 U.S.C. 300u-11) is amended by striking paragraphs

    (7) ,

    (8) , and

    (9) and inserting the following:
 ``

    (7) for each of fiscal years 2026 and 2027, 
 $1,102,000,000;
 ``

    (8) for each of fiscal years 2028 and 2029, 
 $1,327,000,000;
 ``

    (9) for each of fiscal years 2030 and 2031, 
 $1,526,000,000; and''.

SEC. 4. REPORT.

 Not later than 1 year after the date of the enactment of this Act, 
and annually thereafter, the Comptroller General of the United States 
shall submit to Congress a report on how quality-adjusted life years 
negatively impacts individuals with intellectual and developmental 
disabilities and their access to care.
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